downloading a pdf of the Beacon. - Beebe Medical Center

“We are proud to share our initiatives and accomplishments that areincluded here in this special issue of the Beacon.”—Jeffrey M. Fried, FACHE, President/CEO & The honorable William Swain Lee, Chair, Board of DirectorsWe are entering a new era of healthcare in ournation. With reform well under way, we haveto focus even harder on being cost-effective while weprovide high-quality medical care and best serve ourcommunity at the same time. Even as a hospital organization,we also have to focus on the health of ourcommunity outside of our walls. Our role as healthcareproviders does not stop when the patient leavesthe hospital room or one of the outpatient facilities.Our role is to support the health and wellness of allof those in our community. To accomplish this, wemust form partnerships with other healthcare organizations,with our local governmental agencies, andwith the communities that make up Sussex County.We are proud to share our initiatives and accomplishmentsthat are included here in this specialissue of the Beacon. They reflect the continualcommitment and dedication by the Beebe MedicalCenter staff, the physicians, and the leadership toimplement best practices in medicine, to controlinfection, to fight disease, to continually improveprocesses, to adopt the safest and most effectivesurgical procedures, and to support our patientsas they pursue their health and wellness outsideof our doors.Jeffrey M. Fried, FACHEPresident/CEOThe Honorable William Swain LeeChair, Board of DirectorsThe commitment of the entire Beebe MedicalCenter team has been recognized by the Centersfor Medicare and Medicaid Services (CMS) as it hasgathered and analyzed information on our patientoutcomes—how our patients do after they leaveour care.We recently learned that Beebe Medical Centerhas been rated well above the national average—73.3 compared to 55.5 in the federal government’snew “Hospital Value Based Purchasing” system. Butour goal has never been to compare ourselves toaverage organizations. Rather, our goal has alwaysbeen to rank among the very best. This rating systemis extremely important to all U.S. hospitals because,as of this past fall, it directly impacts how much CMSwill reimburse us for the care we give our patients. Ifthe quality of care is inferior, we will be paid less. Ifthe quality of care is superior, we will be paid more.The fact that we are rated so highly directly reflectsthe high quality of care that we offer.Beebe Medical Center is committed to bringingour community cost-effective, safe, quality healthcare.We thank you for supporting us and for joiningus in making Sussex County among the healthiestcounties in the nation.The Quality & Safety Committeeof the Beebe Medical Center Boardof Directors focuses on the Board’soversight responsibility for qualityand safety throughout the organization.Pictured are (seated, left toright): The Honorable WilliamSwain Lee, Chairman of the Boardof Directors; Jeffrey M. Fried,FACHE, President and CEO; AnnSmith, RN, BS, CPHQ, Directorof Quality; (back row): Anis K.Saliba, MD; Paul Minnick, RN, MSN,NEA-BC, Vice President, PatientCare Services; Marcy Jack, Esq.,BSN, CPHRM, Director of RiskManagement; Stephen M. Fanto,MD, Committee Chairman; Jeffrey E.Hawtof, MD, Vice President,Medical Operations & Informatics;Bhaskar S. Palekar, MD; PaulPernice, CPA, Vice President,Finance; and David A. Herbert.Members not pictured are: VikasBatra, MD; William L. Berry;James P. Marvel, Jr., MD; Janet B.McCarty; Paul C. Peet, MD,President of the Beebe MedicalStaff; Ronald Sabbagh, MD; KarenSavidge, RN; and William A.Thomas, Jr., MD.3

4034.030“For the majority of patients to successfully navigate the healthcare system, they need—Megan Williams, director of Population Health and a nurse10practitioner2019.6a caregiver, and it’s important to include him or her on every level.”transportation issues, and insufficient knowledge about the disease or medications.Many patients have a dual diagnosis. Mental illness and chronic pain, forinstance, increases their risk of readmissions. And, most people don’t understandhow to effectively navigate the health system.Hospitalists, case managers, nurses, and community providers, such asprimary care physicians, refer patients into the program. The CAREs team, which,along with a nurse practitioner, includes a social worker and a registered nursewho is also a wellness coach, evaluates the patient. Once the patient is enrolled,the team completes an assessment and baseline questionnaire that includesa comprehensive health history.Setting goals is a key part of the program. These goals will differ dependingon the individual. “We say: ‘We’re here to help for the next 90 days, what is itthat we can help you achieve?’ ” Ms. Williams says. The 53-year-old single father,for instance, wanted to make sure his children were cared for. He also neededto improve his living conditions, which were exacerbating his condition. Theteam connected him with the community-based resources that can provide help.The goals often include a fun activity, such as attending a NASCAR race witha relative or going to the boardwalk to enjoy a summer sunset at the beach. “Wetake these goals very seriously and write them into a unique plan,” Ms. Williamssays. “We want to help them manage their chronic illness and make sure theyunderstand how to take their medication; at the same time, we can incorporatetheir personal goals. For example, we might say, ‘We can help get you to theNASCAR race with your nephew if you work to better manage your heart failure.’By framing goals in this manner, the patient’s level of engagement is reallyheightened.”Knowing how to properly take medication is a transition skill, she explains.So is learning to recognize the red flags that indicate when a patient should callthe doctor. The program also includes the caregiver. “For the majority of patientsto successfully navigate the healthcare system, they need a caregiver, and it’simportant to include him or her on every level,” Ms. Williams says.In addition to improved transition skills, patients have reported an improvedquality of life as a result of being a part of the Beebe CAREs program. Resultsare measured through follow-ups with the patients. Another outcome goal is toreduce utilization and the cost of services. The Beebe CAREs pilot found a 49 percentreduction in the number of readmissions, a 45 percent reduction in the averagelength of stay, a 95 percent improvement in the average transition skills score,and a 44 percent improvement in the average quality of life score.Beebe CAREs is part of a larger movement in healthcare to look beyond thefour walls of a hospital or doctor’s office, Ms. Williams says. “Such programsdetermine how providers and community programs can best collaborate withpatients to improve the quality of healthcare and access to services.” n0605040302010030 DAYS 90 DAYS 365 DAYSRehospitalizations after dischargefrom the hospital among patientsin medicare fee-for-service programsPercent of Patients Rehospitalized (Cumulative)19.634.056.130 DAYS 90 DAYS 365 DAYSNumber of days following discharge from hospitalSouce: Adapted from S. F. Jencks, M. V. Williams, and E. A. Coleman, “Rehospitalizations Among Patients inthe Medicare Fee-for-Service Program,” New England Journal of Medicine, Apr. 2, 2009, 360(14):1418–28.Program OutcomesThere is enough evidence at the .01 level ofsignificance to support our claim of raisingtransition skills and quality of life in patients.The program is statistically proven to help patientsbuild vital skills to cope with the transition periodof discharge and solve social issues affectingquality of life.Average number of 5 2.56 49%readmissionsReductionAverage length of stay 7.89 4.45 45%(number of days)ReductionAverage transition skills score 1.44 25.44 95%ImprovementAverage quality of life score 59.44 32.89 44%ImprovementPre-programPost-ProgramPercent Change5

ProcessImprovementthe Building Block for Quality CareNurses prepare to insert a urinarycatheter (left to right): DeniseLarson, RN, MSN; Theresa Houston,RN, BSN, CCRN; and Ellen Purple,RN, BSN.Process improvement initiatives are ongoing atBeebe Medical Center as employees and leadershipfocus on bringing the best quality medical careto the communities we serve. The collective resulthas been recognized by the Centers for Medicareand Medicaid Services (CMS) through ways in whichit rates Beebe. For example, Beebe Medical Centerhas received a 73.3 rating in the “Hospital ValueBased Purchasing” rating system. This rating putBeebe Medical Center 32 percent higher than thenational average of 55.5, and 53 percent higherthan the Delaware hospital average of 47.9.This rating system is extremely important toU.S. hospitals because as of October 2012, it directlyimpacts how CMS will reimburse hospitals for thecare they give patients. If the quality of care is inferior,hospitals will be paid less. If the quality ofcare is superior, hospitals will be paid more. Therating is based on an analysis of such factors as:• patient outcomes related to how the hospitaltreated them for heart failure, heart attacks, andpneumonia;• how patients fared in regard to their healthduring and after surgery;• patient satisfaction.Beebe patient Holland Franks participates in the conversation between his nurses Joanna Robertson and Michele Robertsonat shift change. His participation is part of the Bedside Reporting initiative to improve communication and the quality ofpatient care.6

For consumers, it also is an important rating. Itmeans that hospitals with a high rating are providinga higher standard of care.Below are two of more than a dozen processimprovement initiatives at the hospital that we’d liketo highlight.The Hands-off Communication Initiative wasborn on the 3rd floor Medical-Surgical Unit (3MS).While in nursing school, nurse Joanna Robertson,RN, had studied about “Bedside Reporting,” a practicethat allows patients to take part in the nurses’daily shift change. Instead of having nurses meetat the nurses’ station to discuss the needs of eachpatient, they instead meet at the bedside and includethe patient, and even family members at the patient’srequest, in the discussion. The patient’s medicalinformation is communicated more quickly to thestaff members of the next shift, creating a seamlessflow of patient care that already has translated intoimproved quality and safety. Satisfaction scores haveincreased dramatically for both nurses and patients.The practice is now being introduced into otherpatient areas.The CAUTI Prevention Initiative acronymstands for “Catheter-associated Urinary TractInfections.” It’s well known that patients can developinfections associated with the use of urinary catheters,so hospitals want to remove them as soon as itis possible. In 2009, a nurse task force was formedto research best-practice recommendations. A nursedrivenurinary catheter discontinuation protocol wasdeveloped and implemented for the early removal ofunnecessary urinary catheters. The new protocol wasreviewed and approved by the Medical ExecutiveCommittee (MEC), which is made up of physicianleaders, and by the hospital’s Nursing Councils forApproval. The Professional Practice Council madesure that all nurses were trained in the new protocoland that additional equipment was purchased. Initialresults show that there has not been a single urinarytract infection in the Intensive Care Unit (where thepilot was introduced) in two years. The initiative wasexpanded hospital-wide in 2011. Since then, theseinfections have decreased by 30 pecent, and therehave been none in the Intermediary Care Unit(IMCU) for a year.These accomplishments reflect the dedicationand commitment across the hospital. In November2012, Beebe Medical Center recognized the processimprovement teams at the annual Quality and SafetyAwards banquet. Three teams were honored. Onewas the “Hands-off Communication” team, the othertwo were “Medical Staff Quality Measures,” whichfocused on the creation of a Medical Staff Committeethat is responsible for the measurement, evaluation,and oversight of the competency and performance ofmedical providers through a multispecialty approachwith an emphasis on the pursuit of excellence andcollegial learning; and the “Coordination of CareInitiative,” which implemented actions to improveand maintain the health of patients with chronic illnessessuch as heart failure after they are dischargedfrom the hospital. nHealthcare Associated InfectionsHealthcare Associated Infections (HAIs) are serious conditions that occurin some hospitalized patients. Many HAIs occur when devices, such ascentral lines and urinary catheters, are inserted into the body. Hospitalscan prevent HAIs by following guidelines for safe care.The Central Line Associated Blood Stream Infections (CLABSI) Score isreported using a Standardized Infection Ratio (SIR). This calculationcompares the number of central line infections in a hospital’s intensivecare unit to a national benchmark based on data reported to NHSN from2006–2008. The result is adjusted based on certain factors such as thetype and size of a hospital or ICU.Three teams received awardsat the Third Annual Quality andSafety Awards banquet. Picturedhere is the presentation to the“Coordination of Care Initiative”team representatives (left to right):Stephen M. Fanto, MD, Quality &Safety Committee Chairman;Dianne Bane, RN; Megan Williams,FNP-COPC; and Jeffrey M. Fried,FACHE, President and CEO ofBeebe Medical Center.Measures used to evaluate patient care Fiscal Year 2011 rates*Air bubble in the bloodstream 0.000 0.003Mismatch blood types 0.000 0.001Severe pressure sores (bed sores) 0.000 0.136Falls and injuries 0.098 0.527Blood infection from a catheter in a large vein 0.000 0.372Infection from a urinary catheter 0.195 0.358Signs of uncontrolled blood sugar 0.000 0.058Beebe Medical CenterU.S. NATIONAL RATEper 1,000 patient discharges7

Integrating careConsidering the Whole PatientCancer Coordinator Clare Wilson,RN, MS, works closely with cancerpatients. Picture here, left to right,Susan Selph with Clare Wilson.Judith Ramirez, EdD, Manager ofPsychosocial Services and Outreachat Tunnell Cancer CenterWhether in the workplace, in the gym, or on theplaying field, professional coaches help peopleto visualize the future, to set goals, and to determinewhat they need to do to achieve them.Beebe Medical Center is taking the sameapproach to wellness. Clare Wilson, RN, MS, forinstance, is the Cancer Care Coordinator at theTunnell Cancer Center. Ms. Wilson, who has both anursing degree and a master’s degree in counseling,is a certified well coach at the center. She’s joined bythe center’s other two well coaches, Jude Johnson-Shupe, MSW, a psychosocial service specialist, andKim Westcott, a registered dietitian. The BeebeCAREs program also has a well coach on its team(see page 4).Similarly, Cancer Nurse Navigator Kathy Cook,MSN, RN, helps patients through the Beebe BreastHealth Center. Located at the Bookhammer OutpatientCenter on Route 24 in Rehoboth Beach, thecenter is the region’s only facility devoted to breastcare, diagnosis, and treatment for men and women.Well coaches and navigators address the patient’sentire well-being. They integrate care as they focuson the individual needs of each patient.Ms. Cook, who is notified when one of herpatients needs to return for more diagnostics, isa one-stop source to answer any of the patient’squestions.“Kathy educates women requiring further breasthealth testing about the next step,” says JudithRamirez, EdD, Manager of Psychosocial Services andOutreach at Tunnell Cancer Center. “If it’s a biopsy,8

Well coaches and navigators address the patient’s entire well–being. They integratecare as they focus on the individual needs of each patient.she explains the procedure. She might provide informationabout an ultrasound or a lumpectomy ormastectomy.”Not only does she answer questions, but she’llalso help patients make appointments for furthertesting. She’s happy to accompany them to theirappointments, and some patients take her up onthe offer. “I try to meet whatever their need is,” saysMs. Cook, who has received a certification in breasthealth navigation. “I’m their point of contact.”In addition to digital mammography, breast ultrasound,and minimally invasive breast biopsies, theBreast Health Center also provides care for peoplewith benign breast disease. Ms. Cook calls patients tomake sure they’ve scheduled the appropriate followupappointments. She also teaches them how to selfexaminetheir breasts.Most patients are happy to have someone to talkto, she says. Dr. Ramirez agrees: “In the six monthssince we started the nurse navigator program, I’vereceived many kudos for Kathy’s services. It’s allabout the emotional connection.”Forming an emotional connection is also part ofthe work that Clare Wilson does as the Cancer CareCoordinator. “Patients are not just their cancer andthey are not just patients; they are a whole person.We integrate the mind, body, and spirit,” she says.Consider the patient who recently completedradiation or chemotherapy, an occasion TunnellCancer Center marks by inviting patients to ring abell. Heard more than 1,000 times a year, the soundstands for courage, hope, triumph, strength, faith,and love.Ms. Wilson helps cancersurvivors define whothey are in the presentand envision themselvesthree months down theroad. “Coaching alwaysstarts with a vision,” sheexplains. “It should be aBreast cancer survivor Esselee Davisrings the bell at the Tunnell CancerCenter, signifying courage, hope,triumph, strength, faith, and love.powerful statement and an active statement, suchas ‘I am strong and back to work,’ or ‘I am livingpeacefully.’”The vision statement leads to goals. The goalsmeet wellness objectives, such as starting a healthydiet, gaining strength, or becoming more active.Once vision and goals have been identified, Ms.Wilson and her client discuss the unique strengthsthe person possesses that can help them realize thatgoal. They also review any barriers, and they talkabout how they might overcome these challenges.Jude Johnson-Shupe and Kim Westcott, in theirwell-coaching roles, work in the same manner withpatients.Well coaches are available to meet with caregiversand family members. They counsel those who havelost loved ones. Ms. Wilson also coordinates carebetween other facilities for those patients who dividetheir time between residences or who have soughta second opinion or specialized care outside ofTunnell Cancer Center. Both Ms. Wilson and Ms.Cook agree that navigating and counseling patients,and supporting them in the integration of their careand in focusing on their individual goals and vision,is indeed a rewarding endeavor. nRight, Kathy Cook, MSN, RN,Nurse Navigator at the BeebeBreast Health Center, guidespatients who have received apositive diagnosis for cancer throughthe process of scheduling appointments,treatments, and surgery.9

Working togetherCollaborating with the Community to Improve HealthEd Kee, Secretary of Agriculture forDelaware, and Jeffrey M. Fried,FACHE, President and CEO of BeebeMedical Center, shake hands on abeautiful sunny day. Both men arefocused on improving the health ofDelaware.Beebe Medical Center’s vision is for SussexCounty to be one of the healthiest counties inthe nation. To succeed, Beebe Medical Center hascreated initiatives to work together with other hospitalsin Sussex County, community organizations,state and county representatives, and others toimpact the health of all the people who live andwork in this vast county.Healthier Sussex County: In July of 2012,Beebe Medical Center, Nanticoke Memorial Hospital,and Bayhealth Medical Center announced HealthierSussex County, an initiative to improve the health ofresidents through providingresources where theyare needed. Diabetes andmammography were identifiedas the first areas tofocus on. Informationcollected by the Stateof Delaware reveals thatthe prevalence of type 2diabetes in the countyincreased from 9.9 percent of the adult populationin 2008 to 11.6 percent in 2009. Mammography,which is used to screen for breast cancer, is importantbecause Sussex County has a higher rate ofbreast cancer than the national average.Local communities: Besides working throughthis collaborative, Beebe Medical Center has focusedon both these health issues independently. ItsDiabetes Management Department offers diabeteseducation that is available through a physician referral.Diabetes Educator Tina Trout, ACNS-BC, CDE,The Honorable William Swain Lee, Chairman of the Beebe Medical CenterBoard of Directors; Esthelda R. Parker-Selby, a member of the Beebe Boardof Directors; and Rev. Fred Hopkins are involved with the effort to improvethe health of those who live and work in Sussex County.The three hospitals in Sussex County have come together to tackle healthdisparities. Pictured here (left to right) are Steven A. Rose, FACHE, President andCEO of Nanticoke Memorial Hospital; Terry M. Murphy, FACHE, President and CEOof Bayhealth Medical Center; and Jeffrey M. Fried, FACHE, President and CEO ofBeebe Medical Center.10

often speaks at free screening events, whether sponsoredby Beebe Medical Center or local communityorganizations. Beebe Medical Center’s PopulationHealth Department offers regular free glucosescreenings at health events. Beebe Medical Centeralso offers free glucose screenings every Wednesdayat its labs in Millville, Milton, Rehoboth Beach, andat the hospital. The results of all of the free glucosescreenings are sent to the Population HealthDepartment, which follows up with patients.Through the Sharing Our Stories, Saving OurSisters (SOS 2 ) program, Beebe Medical Center’sTunnell Cancer Center uses professional cancerscreening nurse navigators and lay health navigatorsto reach women who, through lack of health insurance,health knowledge, or other reasons, have traditionallynot been diagnosed until the later stages ofbreast cancer. Mortality rates, for example, in theAfrican-American population are higher than in theCaucasian population. The program, funded througha grant from the Philadelphia Affiliate of the Susan G.Komen for the Cure organization, also covers thecost of co-pays if the women are financially eligible.These free breast cancer screenings are offeredmonthly to women who qualify at Tunnell CancerCenter through Breast Health Forums. Screeningsalso are offered at several different locations whenprogram representatives have reached out to otherorganizations. Since this program was initiated in2010, more than 3,573 women have been educated.Of those, 1,323 were navigated for screening and285 had their mammograms funded by the Komengrant. Partnerships also have been created with severalcommunity organizations to reach out to evenmore women.Affiliation with Nanticoke Cancer CareServices: This year, Nanticoke Cancer Care Servicesaffiliated with Tunnell Cancer Center. This affiliationallows Beebe Medical Center medical and radiationoncology physicians to treat patients at NanticokeCancer Care Services in Seaford, Delaware. This affiliationexpands support services for Nanticokepatients, brings clinical trial participation to Seaford,and provides for valuable upgrades to the technologyavailable at Nanticoke. The affiliation also hasstrengthened the relationship of the state’s cancercare professionals in their effort to improve the overallhealth of the state’s population.Quality Insights of Delaware: Beebe MedicalCenter has joined with Quality Insights of Delaware,Nanticoke Memorial Hospital, home health agencies,and hospice in the Southern Delaware CareTransition Community initiative to look at waysto improve how patients transition from hospitalcare to their homes or to other care facilities. EllenTolbert, Director of Patient Relations at BeebeMedical Center, is working with her dischargeplanners to identify patient needs before theyleave the hospital. nSOS 2 held a “Girls Night Out”dinner event in September at theAtlantic Sands Hotel in RehobothBeach to celebrate breast cancer survivors.A movie was shown thathighlighted local survivors and theircommitment to hope and life. Theevent was sponsored by HealthierSussex County, Susan G. Komen forthe Cure, and SWAP ProductionsLLC, the producer of the movie.Nearly 40 local organizations andbusinesses supported the event.Several hundred survivors, theirfamilies, their spouses, and theircaregivers attended. Pictured hereenjoying the event are two-timebreast cancer survivor CarolynSpence and her husband Matt.visit healthiersussexcounty.comto access more informationabout healthier Sussex countycollaborative initiative11

you canExpectExcellence from usBeebe orthopedic surgeons performa total knee replacement.Beebe Home Health physical therapistLinda Culleny, PT, helps AmeliaVinciguerra of Ocean View gainflexibility and strength followingher knee replacement surgery.Beebe Medical Center received theOrthopedic Surgery Excellence Awardfor 7 Years in a Row (2007–2013)Heathgrades ® rates Beebe MedicalCenter Among the 100 Best Hospitals forOrthopedic Surgery, Joint Replacement,and Spine Surgery for 2 Years in a Row(2012 & 2013)Beebe Medical Center is a leader in orthopedicsurgery. Beebe Medical Center is certified bythe Joint Commission for hip and knee replacementsurgeries. Highly trained surgeons perform kneereplacements, hip replacements, and surgical proceduresto correct back problems. Many patients onceagain have been able to take part in activities thatpain, arthritis, damaged joints, and bad backs hadprevented them from enjoying.For seven years in a row, Healthgrades, an independentrating agency, has recognized Beebe MedicalCenter with the Orthopedic Surgery ExcellenceAward. Healthgrades ratings that have led to thisaward are based on about 40 million Medicare hospitalizationrecords for services performed from 2009through 2011 at approximately 4,500 short-term,acute care hospitals nationwide. Healthgrades independentlymeasures hospitals based on data thathospitals submit to the federal government. Nohospital can opt in or out of being measured, andno hospital pays to be measuredThese awards reflect the commitment of theentire staff and members of Beebe Medical Center’scomprehensive orthopedic program: the surgeonswho are members of the Beebe Medical Staff, theBeebe team members who specialize in caring fororthopedic patients, and those who are on theorthopedic surgical teams.Over the years, the number of Beebe MedicalStaff orthopedic surgeons has grown to 12. Theyinclude experts in joint replacement, shoulder surgery,and surgical procedures of the spine. Thesesurgeons use many of the latest technologies andare making a difference in their fields. Patients havegained important information as they prepare forjoint replacement and back surgeries from BeebeMedical Center orthopedic staff in patient educationclasses. Surgical patients, following their procedures,stay in a dedicated unit of the hospital where staff isspecially trained to care for them.12Orthopedic 2 0 1 3

visit beebemed.org For a complete list of the 2013 Healthgrades ®ratings achieved by Beebe Medical Center.Healthgrades ® ranked Beebe MedicalCenter Among the Top 5% in the nationfor Coronary Intervention Proceduresfor 2 Years in a Row (2012 & 2013)#1 in Delaware for Coronary InterventionProcedures for 3 Years in aRow (2011–2013)Heart disease is a leading killer of men andwomen in the United States. Each year more than900,000 people suffer from heart attacks. A majorcause of heart attacks is a blockage in the arteries ofthe heart (coronary arteries). Coronary interventionsare medical procedures that interventional cardiologistsperform in the hospital’s Cardiac CatheterizationLaboratory to open the arteries in the heart and, ifnecessary, to put stents in to keep them open.For three years in row, Healthgrades has ratedBeebe Medical Center #1 in Delaware for these procedures.It also has ranked Beebe One of America’s100 Best Hospitals for Coronary Interventions for2012 and 2013.Beebe Medical Center’s InterventionalCardiology program is part of Beebe MedicalCenter’s Cardiac and Vascular Services program.Board Certified interventional cardiologists performthe procedures in emergency situations whenpatients are suffering a heart attack caused by ablockage in an artery. They also perform them totreat patients who are scheduled for interventionalprocedures, either as a diagnostic procedure or tohelp prevent a heart attack.Beebe Medical Center’s Interventional Cardiologyprogram is supported through a comprehensivecollaboration between the Emergency Department,where patients often arrive first; the dedicatedCardiac Catheterization Laboratory nurses, staff, andphysicians; the Intensive Care Unit; and dedicatedcardiac units that care for patients before and afterthe procedure. And, in case the patient needssurgery, Beebe Medical Center also has dedicatedcardiothoracic surgeons on staff and a fully accreditedCardiothoracic Surgery program on-site at thehospital in Lewes.Signs of a heart attack• Pain or discomfort in the center of the chest—the most common sign in both men and women• Pain or discomfort in other areas of the upperbody, including the arms, back, neck, jaw, orstomach• Other symptoms, such as a shortness of breath,breaking out in a cold sweat, nausea, or lightheadednessWomen are somewhat more likely than men toexperience signs other than discomfort in the chest,particularly shortness of breath, nausea/vomiting,and back or jaw pain.Call 9-1-1 immediately if you or someoneyou know is experiencing these symptoms.Remember, minutes matter!Beebe’sCardiacCath Labi. Diagnostic Cathsii. Procedures in theCath Lab• Cardiac Catheterizations> Percutaneous coronaryinterventions(PCI) including:> Balloon angioplasty> Coronary stenting• Cardioversions• Loop Recorders• Pacemakers• Generator Changes• TransesophagealEchocardiograms (TEE)• TEE with CardioversioniiI. ElectrophysiologyservicesA patient’s cardiac arteries are examined during a cardiac catheterization prior to placing a stent.CoronaryInterventions 2 0 1 313

Vascular surgeon Mayer Katz, MD,performs cutting-edge vascularsurgery at Beebe Medical Center.Healthgrades ® ranked Beebe MedicalCenter #1 in Delaware for VascularSurgery in 20135-Star for Carotid Surgery in 2013Healthgrades has ranked Beebe Medical Center#1 in Delaware for Vascular Surgery in 2013.Additionally, it has given Beebe Medical Center a5-Star rating for Carotid Surgery for 2013. Accordingto the Healthgrades study, the risk of death is 75 percentlower at hospitals receiving 5 stars compared to1-star-rated hospitals. Patients also have a 61 percentlower risk of complications at 5-star hospitals comparedto 1-star-rated hospitals.Vascular surgery is an important aspect of BeebeMedical Center’s Vascular Services program thatincludes vascular diagnostic testing and other vascularnonsurgical procedures. Beebe Medical Center’sexperienced vascular surgeons, with support fromsurgical teams and the latest technologies, performsurgeries to either open or repair blood vessels,other than the ones in the heart, so that blood flowsmore freely to the body.Mayer Katz, MD, and vascular surgeon Joseph Haydu, DO, review patientfilms in their office at Delaware Bay Surgical Services in Lewes.Vascular disease can lead to disability, amputation,stroke, aneurysms, and even death. It is causedwhen arteries are blocked, such as in the disease ofatherosclerosis.Vascular procedures performed at Beebe MedicalCenter to treat vascular disease include:Carotid endarterectomy surgery: This is a commonsurgery performed at Beebe Medical Center andan extremely important one to the health and wellbeingof patients. It is performed when the patienthas received a diagnosis of a blockage in one or bothof the carotid arteries, which are the main vesselscarrying blood to the brain. A blockage can lead to alife-threatening stroke.Abdominal aortic aneurysm endovascular repair:This procedure repairs an abdominal aortic arterythat has an aneurysm, which is a bulge in the side ofthe artery wall. This artery is large and carries bloodfrom the heart to the rest of the body. An aneurysmhas the potential to rupture, thus becoming lifethreatening.This repair is performed through thearteries, thus avoiding major surgery.Femoral-femoral bypass: This surgical procedureimproves circulation in the lower extremitiesthrough the creation of a new path for blood toflow around the blockage.Vascular surgeon Mayer Katz, MD, assisted by a vascular surgical and interventional radiology team, performs endoscopicsurgery to repair an abdominal aortic aneurysm. Pictured here (left to right) are Andrea Montgomery, RT(R), CT;Dr. Katz; Elizabeth Adkins, RN; Jen Levan, RNFA; and Jeannine Holland, OR Tech.14VascularSurgery 2 0 1 3

Healthgrades ® ranked Beebe MedicalCenter #1 in Delaware for CardiologyServices in 2013Beebe Medical Center received a 5-starrating in Cardiology Services in 2013Beebe Medical Center offers the community acomprehensive cardiac program that focuses onboth prevention and treatment. It includes diagnostictesting, coronary interventions (see page 13), surgery,rehabilitation for those who have suffered a cardiacepisode such as heart attack, and education forpatients with chronic heart disease. Our commitmentto quality care is reflected in Healthgrades rankingBeebe Medical Center #1 in Delaware for CardiologyServices in 2013. The individual services withinBeebe’s Cardiac and Vascular Services program arerecognized for the high standard of care they offer.For example, the Intersocietal Commission for theAccreditation of Echocardiography Laboratorieshas accredited our Vascular Lab and our NuclearCardiology Lab. This past year, it also accreditedour Cardiac Echo Lab.Beebe Medical Center, during 2012, expandedits cardiac electrophysiology services to better treatpatients who suffer from arrhythmia and other electricalproblems of the heart. Beebe purchased newtechnologies that help electrophysiologists diagnosethe causes of these irregular heartbeats. These specializedcardiologists are now able to better:• evaluate the effectiveness of certain medications incontrolling the heart rhythm disorder;• predict the risk of a future cardiac event, such assudden cardiac death;• assess the need for an implantable device, such asa pacemaker, or a treatment procedure such as aradio frequency catheter ablation.Beebe Cardiac Testing also offers physicians andtheir patients continuous heart monitoring throughthe use of an innovative Zio ® patch (www.irhythmtech.com).This is a small, water-resistant patch thatCardiac surgeon M. L. Ray Kuretu, MD, performs an aortic valve replacement.is applied to the patient’s chest at Beebe MedicalCenter and causes almost no discomfort.Beebe Medical Center’s Cardiac Rehabilitationprogram, which has been in existence for more than30 years, in the spring of 2012 again was awardedCardiac Rehabilitation Recertification through theAmerican Association of Cardiovascular andPulmonary Rehabilitation (AACVPR) until August 31,2015. In 2003, it was the first program to be certifiedin the state of Delaware. nCardiacsurgery(most commonprocedures; othersas necessary)• Coronary ArteryBypass Grafting• Aortic ValveReplacement• Mitral Valve Repairand Replacement• Tricuspid ValveRepair• Aortic AneurysmRepair• Aortic DissectionRepair• Pericardial Windowfor PericardialTamponade• Pulmonary VeinIsolation for AtrialFibrillation• Sternal PlatingRose Iudici, a patient and a volunteerfrom Lincoln, works on theNuStep, purchased with funds fromTreat the Beat. The NuStep is a lowimpactexercise machine that providesa total body cardiovascularworkout. Cardiac rehab nurse JohnAchey, RN, works with Rose.CardiologyServices 2 0 1 315

community reportHospital Quality MeasuresEileen Hardy, RN, puts a sequential compression wrap on a patient prior tosurgery to improve circulation and prevent deep vein thrombosis. CarolynMorris, PCT, assists.The federal Centers for Medicare & Medicaid Services (CMS) requires hospitalsto report on their performance in treating patients with heart attack, heartfailure, pneumonia, and those who undergo surgery (surgical care improvement).CMS uses this detailed, documented patient care information to gauge how wellhospitals throughout the nation perform in these categories.CMS then takes these measures and translates them into a rate or percentage.This allows each hospital, and all consumers, to assess a hospital’s performancecompared to other hospitals. These “hospital compare” measures are availableon the government website www.hospitalcompare.hhs.gov.Beebe Medical Center has established protocols that follow best practiceguidelines to maintain quality patient care. Here, we would like to share ourQuality Measures results in detail during the calendar year 2011.Quanda Custis, RN, warms a patientwith a BAIR Paws warming wrapprior to surgery.Surgical Care ImprovementMeasures used to evaluate patient care calendar year 2011 rates*Percent of outpatients having surgery who got an antibiotic at the right time (within one hour before surgery). 99% 95% 96%Percent of surgery patients who were given an antibiotic at the right time (within one hour before surgery)to help prevent infection. 99% 99% 98%Percent of surgery patients whose preventive antibiotics were stopped at the right time(within 24 hours after surgery). 100% 98% 97%Percent of surgery patients who got treatment at the right time (within 24 hours before or after their surgery)to help prevent blood clots after certain types of surgery. 99% 96% 97%Percent of outpatient surgery patients who were given the right kind of antibiotic to help prevent infection. 98% 97% 96%Percent of surgery patients who were taking heart drugs called Beta Blockers before surgery, who were kept onthe drug during the period just before and after surgery, making it less likely that they will have heart problems. 99% 97% 96%Percent of surgery patients who were given the right kind of antibiotic to help prevent infection. 100% 99% 98%Percent of all heart surgery patients whose blood sugar (blood glucose) was kept under good control in thedays after surgery to lower the risk of infection. 100% 98% 95%Percent of surgery patients needing hair removed from the surgical area before surgery, who had hairremoved using a safer method than a razor to reduce the risk of infection. 100% 100% 100%Percent of surgery patients whose urinary catheters were removed on the first or second day after surgery. 99% 95% 94%Percent of patients having surgery who were actively warmed in the operating room or whose bodytemperature was near normal by the end of surgery. 100% 100% 100%Percent of surgery patients who had blood clot prevention ordered after certain types of surgery. 99% 98% 98%Beebe AverageDelaware Averagenational Average*2011 = January 2011 to December 2011; Source: U.S. Department of Health and Human Services, Hospital Compare www.hospitalcompare.hhs.gov16

Heart FailureMeasures used to evaluate patient care calendar year 2011 rates*Percent of heart failure patients given instructions to help understand and manage the symptoms of this chroniccondition. 97% 94% 92%Percent of heart failure patients given an evaluation of left ventricular systolic (LVS) function. This is a test todetermine whether the left side of the heart is pumping properly. 100% 100% 99%Percent of heart failure patients given ACE Inhibitor or ARB (medications) for left ventricular systolic dysfunction(LVSD) (decreased function of the left side of the heart). These medications reduce the work the heart has toperform. 98% 97% 96%Percent of heart failure patients given cessation smoking advice/counseling to decrease the risk of developingblood clots or heart and lung disease. 100% 100% 99%Beebe AverageDelaware Averagenational AverageLinde Semone, hostess in the DietaryDepartment, reviews a cardiac dietwith a cardiac bypass patient.Heart Attack (Acute Myocardial Infarction)Measures used to evaluate patient care calendar year 2011 rates*Percent of heart attack patients given aspirin at arrival; this may help reduce the severity of the attack. 99% 99% 99%Percent of heart attack patients given percutaneous coronary intervention (PCI) within 90 minutes of arrival.PCI is a procedure to open blocked blood vessels in the heart to help prevent further heart muscle damage. 97% 94% 94%Percent of heart attack patients given ACE Inhibitor or ARB (medications) for left ventricular systolic dysfunction(LVSD) (decreased function of the left side of the heart). These medications reduce the work the heart has toperform while lowering blood pressure. 100% 97% 97%Percent of heart attack patients given smoking cessation advice/counseling. 100% 100% 100%Percent of heart attack patients given aspirin at discharge to reduce the risk of another attack. 99% 100% 99%Percent of heart attack patients given Beta Blockers at discharge. This medication lowers blood pressure whiletreating chest pain and heart failure. 99% 99% 99%Percent of heart attack patients given a prescription for a statin at discharge. 98% 98% 97%Trauma nurses rush a patientwith cardiac symptoms from theEmergency Department to theCath Lab.PneumoniaMeasures used to evaluate patient care calendar year 2011 rates*Percent of pneumonia patients given initial antibiotic(s) within six hours of arrival. Early treatment with antibioticscan cure bacterial pneumonia and reduce the possibility of complications. 99% 95% 96%Percent of pneumonia patients whose initial emergency department blood culture was performed prior to theadministration of the first hospital dose of antibiotics. A blood culture is a test to identify what type of bacteriacaused the pneumonia. 100% 96% 97%Percent of pneumonia patients given the most appropriate initial antibiotic(s). 100% 95% 95%Percent of pneumonia patients given smoking cessation advice/counseling. Smoking increases a person’schances of getting pneumonia or other chronic lung diseases. 99% 99% 98%Percent of pneumonia patients assessed and given pneumococcal vaccination. This vaccination may help preventor lower the risk of complication of pneumonia. 100% 96% 95%Percent of pneumonia patients assessed and given influenza vaccination during flu season to protect them fromanother lung infection and to help prevent the spread of influenza (flu). (Offered during flu season only,October through March.) 100% 97% 93%Respiratory therapist Lori Gooch,RRT, checks a patient’s lung capacityusing an incentive spirometer.*2011 = January 2011 to December 2011; Source: U.S. Department of Health and Human Services, Hospital Compare www.hospitalcompare.hhs.gov17

Financial Report & Community Benefit ReportComparative Consolidated Statements of Operationsfor the twelve months ending June 30, 2012Fiscal Year.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . June 2012 June 2011PATIENT REVENUEInpatient Revenue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $312,400,906 $297,620,525Outpatient Revenue.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361,497,972 307,219,589Total Patient Revenue.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $673,898,878 $604,840,114REVENUE DEDUCTIONSWe did not receive full payment:Medicare, Medicaid, and Commercial. . . . . . . . . . . . . . . . . . . . . . . . . . $378,607,354 $329,075,925Prior Year Medicare Settlements .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ($92,240) ($90,670)Charity care & other allowances.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,008,683 13,746,659Total Revenue Deductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $393,523,797 $342,731,914Total Net Patient Revenue .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $280,375,081 $262,108,200Other Operating Revenue.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,814,988 4,626,102Total Operating Revenue.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $284,190,069 $266,734,302OPERATING EXPENSESSalaries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $105,663,687 $96,408,723Contract Labor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,568,949 5,353,890Employee Benefits .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,795,988 34,428,121Physician Fees.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,977,364 8,236,434Patient-related Supplies & Services.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56,002,940 51,515,788Non-patient-related Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,648,547 3,513,088Utilities .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,565,886 5,526,097Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,331,896 1,284,162Depreciation and Amortization.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,466,986 17,261,030Interest .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,225,623 2,401,712Bad Debt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,350,873 13,205,113Repairs & Maintenance .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,780,687 5,523,619Other Expenses.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,065,003 21,593,220Total Operating Expenses .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $287,444,429 $266,250,997Income (loss) From Operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ($3,254,360) $483,305Analysis of ServiceAdmissions .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,761 8,794Average Length of Stay (Days) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.15 4.19Inpatient Days of Care.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36,333 36,833Cardiac Catheterization Procedures (Inpatient and Outpatient).. . . . . . . . . . . . . . . . 1,709 1,454Births .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 889 829Emergency Visits, including Millville seasonal facility .. . . . . . . . . . . . . . . . . . . . . . 50,849 50,403Laboratory Tests (Outpatient). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 675,939 626,840Radiation Oncology Procedures (Outpatient).. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,415 9,649Radiology Procedures (Outpatient) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108,728 106,015Rehabilitation Visits (Outpatient).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72,839 72,100Surgical Procedures (Inpatient and Outpatient). . . . . . . . . . . . . . . . . . . . . . . . . . . 12,710 11,780Beebe Physician Network Visits (Office Visits plus OP Visits).. . . . . . . . . . . . . . . . . 47,034 44,277Beebe Physician Network Hospital Inpatient Visits. . . . . . . . . . . . . . . . . . . . . . . . . . 38,672 33,768Home Health Visits.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,824 13,50718

For Our CommunityAfter Ringing the BellA Cancer Survivorship ConferenceHosted by the Sussex County Survivorship CoalitionJanuary 17, 20138 a.m.–2:30 p.m.Atlantic Sands HotelRehoboth Beach, DelawareLillie Shockney, RN, BS, MASJohns Hopkins Breast Center andSurvivorship ProgramsTopic: Survivorship Care PlansSage Bolte, PhDInova Health SystemLife with Cancer ProgramTopic: Sexuality and SurvivorshipJudy Pierson, EdDLicensed PsychologistRehoboth Beach, DETopic: Your Best Life After CancerOffered at no cost, this conference is intended for cancer survivors and healthcare professionals.For more information or to register, please contact Jo Allegro-Smith via email at jallegro@cscde.org or phone (302) 645-9150.Beebe Medical Center DirectoryGeneral Information . . . . . . . . . . . . 645-3300Outpatient SchedulingServices . . . . . . . . . . . . . . . 645-FAST (3278)Beebe Imaging—Lewes. . . . . . . . . . . . . . . . . . . . . 645-3275—Georgetown . . . . . . . . . . . . . . . . 856-9729—Millville . . . . . . . . . . . . . . . . . . . 539-8749—Rehoboth Beach . . . . . . . . . . . . . 645-3010Beebe Lab Express—Lewes . . . . . . . . . . . . . . . . . . . . . 645-3568—Georgetown . . . . . . . . . . . . . . . . 856-7781—Long Neck . . . . . . . . . . . . . . . . . 947-1202—Millsboro . . . . . . . . . . . . . . . . . . 934-5052—Millville . . . . . . . . . . . . . . . . . . . 539-1620—Milton . . . . . . . . . . . . . . . . . . . . 684-8579—Rehoboth Beach . . . . . . . . . . . . . 645-3010Beebe Rehab Services—Lewes. . . . . . . . . . . . . . . . . . . . . 645-3235—Millsboro . . . . . . . . . . . . . . . . . . 934-1500—Millville . . . . . . . . . . . . . . . . . . . 539-6404—Rehoboth Beach . . . . . . . . . . . . . 645-3010Breast Health Center . . . . . . . . . . . 645-3630Population Health . . . . . . . . . . . . . . 645-3337Diabetes Management . . . . . . . . . . 947-2500Emergency Services—Lewes. . . . . . . . . . . . . . . . . . . . . 645-3289Gull House Adult Activities . . . . . . 226-2160Hastings HeartCare Center . . . . . . 645-3258Home Health Agency . . . . . . . . . . . 854-5210Health Information Management . 645-3282Patient Advocate . . . . . . . . . . . . . . 645-3547Patient Financial Services . . . . . . . 645-3546Patient Information . . . . . . . . . . . . 645-3307Physician Referral Service . . . . . . . 645-3332Tunnell Cancer Centerat Beebe Health Campus—Cancer Screening . . . . . . . . . . . . 645-3169—Medical Oncology . . . . . . . . . . . . 645-3770—Radiation Oncology . . . . . . . . . . . 645-3775Vascular Lab . . . . . . . . . . . . . . . . . . 645-3710Volunteer Services . . . . . . . . . . . . . 645-3531Wound Care Services . . . . . . . . . . . 947-2500twitter.com/beebemedicalFind the link on our website,www.Beebemed.org.Our VisionOur vision is for Sussex County to be one of the healthiest counties in the nation.Our MissionBeebe Medical Center’s charitable mission is to encourage healthy living, preventillness, and restore optimal health with the people residing, working, or visiting thecommunities we serve.The Beacon is published by Beebe Medical Center to present health informationto the people of Sussex County. Health information provided in theBeacon should not be substituted for medical advice offered by a physician.Please consult your physician on medical concerns and questions.Jeffrey M. Fried, President and CEO, jfried@bbmc.orgKelly Griffin, Director, Marketing and Communications, kgriffin@bbmc.orgSusan L. Towers, Editor, stowers@bbmc.orgNancy L. Cummings, Coordinator, ncummings@bbmc.orgPam George, Contributing WriterWith photography by Kevin Fleming and Scott NathanWith design by Dean Design & Marketing Group, Inc.Lewes, Delaware • (302) 645-3300 • www.beebemed.org